Department of Ophthalmology, Ankara Training and Research Hospital, Ministry of Health, Ankara, Turkey.
Ophthalmic Res. 2013;49(2):59-65. doi: 10.1159/000345477. Epub 2012 Dec 15.
The eye is probably the most attractive site of the body for treatment using locally delivered therapeutic agents. An ideal indication for such an approach is noninfectious posterior uveitis. Since intraocular structures of the posterior segment are difficult to reach and are otherwise accessible only by systemic treatment, current interest is focused on the pros and cons of intravitreal drug delivery. Because of its chronic and recurrent nature, the long-term release of anti-inflammatory agents is a major treatment goal. Intravitreal injections, intravitreal implants and biodegradable devices are the most commonly used and approved approaches to deliver various agents to the vitreous. Because of their broad and potent effects, corticosteroids (CS) have been the first-line candidates for intraocular delivery. An increasing spectrum of CS preparations including nondegradable and biodegradable devices is currently available. Since repeated and long-term applications bear the risk of steroid-related complications such as increased intraocular pressure and cataract, alternative agents are currently being tested. Intravitreal injection of methotrexate, anti-VEGF (vascular endothelial growth factor), anti-TNFα (tumor necrosis factor α) and sirolimus have also been applied in patients with conflicting results. Intravitreal treatment has significantly reduced the incidence of adverse effects compared to systemic application, but due to greater ocular side effects there are still some limitations.
眼睛可能是身体最具吸引力的治疗部位，适合使用局部递药治疗剂。对于这种方法，一个理想的适应证是非感染性后葡萄膜炎。由于后节眼内结构难以到达，且只能通过全身治疗才能到达，因此目前的兴趣集中在玻璃体内药物递送的优缺点上。由于其慢性和复发性，长期释放抗炎药是主要的治疗目标。玻璃体内注射、玻璃体内植入物和可生物降解装置是最常用于将各种药物递送到玻璃体内的方法。由于其广泛而有效的作用，皮质类固醇（CS）一直是眼内递药的首选药物。目前有越来越多的 CS 制剂，包括不可降解和可降解装置。由于重复和长期应用存在与类固醇相关的并发症的风险，如眼压升高和白内障，因此目前正在测试替代药物。甲氨蝶呤、抗血管内皮生长因子（VEGF）、抗肿瘤坏死因子α（TNFα）和西罗莫司的玻璃体内注射也已应用于具有矛盾结果的患者。与全身应用相比，玻璃体内治疗显著降低了不良反应的发生率，但由于眼部副作用更大，仍存在一些局限性。
